Everything about menstrual cycle in women (menstruation)

What is a menstruation / Menstrual cycle / Menses?

Menstruation (from Latin: Menstruatio s. menses - menstruation) is the external expression of the menstrual cycle for women. Under menstruation, it is understood the coming disposal after the death of the egg cell, of the preliminary prepared lair for the expected fertilized egg cell, but the functional layer of the endometrium was not used with that purpose and it occurs with bleeding. Therefore, bleeding from the uterus, in which such physiological and anatomical conditions are missing, is not a real menstrual bleeding. Menstruation is periodically repeated from the puberty to the menopause, every 28 days on average. The shortest normal interval is 21 days, and the longest - 35 days. Out of these limits, the menstruation is considered as abnormal in terms of the frequency of its appearing. The different length of the menstrual interval for every particular woman is explained with hereditary and individual characteristics of the woman.


Menstrual period is rhythmic and regular, when the menstruations in the woman alternate at regular intervals. With some women, the exact regularity of menstruation is kept even if there are significant changes in their lives. With others, menstruation comes at different intervals, and the individual intervals can be normal or abnormal. In such cases menstruation is noted as arrhythmic or irregular. The variation in the interval of 2 - 3 days is quite common. This light arrhythmic of menstruation in otherwise normal intervals does not speak about pathological state of the genitals. Changes in the rhythm of the cycle can easily appear in neuro-vegetative and neuro-psychological irritations and especially when there are changes in the environment. During puberty, menopause and after pregnancies and abortions, arrhythmic in menstruation is quite common.

How to calculate your menstrual cycle in Period28.com?

Period28.com differs from other calendars because it is not needed to enter the period of the cycle which is something that some of the women does not know, and it is giving prognosis about the next menstruation according to the individual data.

Example: When you enter the correct data for two consecutive menstrual cycles, the site calculates when the next one is going to be, on the basis of the data, pointed out by you.

For those who know the period of their cycle, you can enter it at the beginning of the registration or to change it at any time from settings.


Menstruation goes on for a definite period of time and stops spontaneously. The average duration of menstruation is 5 days, and the second and the third day are the strongest. The normal range is between 3 and 5, maximum 7 days. The usual duration of menstruation for one woman is quite constant and it could pretty rarely show some kind of fluctuation. If the difference becomes really large, this is a sign of pathological aberration. The mechanism for stopping the menstruation is the same as at giving birth: the open blood vessels are being compressed by the muscle fibres under the influence of the uterine contractions.

Properties of the menstrual blood

Menstrual blood has a characteristic red-brown colour; it is a liquid and is difficult to clot. This is due to the substances, formed in the standing fallopian mucosa, which inactivate, neutralize or destroy the clot ferments. The presence of coagulum is a sign that the bleeding is stronger than the norm.

The menstrual blood has myxomatous look and is sticky when you touch it, which is due to the fact that it is mixed with cervical mucus. It has specific odour due to the secretion impurities of the sebaceous glands of the vulva. As a result of degradation phenomena which can occur under the action of bacteria from the vagina or the external genitals, especially in poor hygiene, menstrual blood can get strong and unpleasant, even fetid odour.

Repercussions on the general state

Menstruation is a process, which occurs almost regularly with disturbances of general and local matter. Only about 16 - 18 % of women do not have any complaints. Some familiar changes, called premenstrual syndrome, precede bleeding. Some disturbances appear in the middle of the interval. These disturbances are subjective and objective. Most of the typical subjective sensations are:

  • pain in the back and low in the abdomen
  • headache
  • nervousness
  • fatigue and tiredness
  • increased excitability
  • gastrointestinal spasms
  • breast tension
  • puffiness

Sometimes a number of disturbances are observed, as for example in the digestive system: decreasing the appetite, aversion to certain food, nausea, vomiting, diarrhoea or constipation. It could be established pulse acceleration, palpitation, etc. The symptoms of vasomotor instability are quite commonly met, and they are expressed in a feeling of heat, quite heavy perspiration, etc. Meanwhile, the nose and the throat swell. The voice loses its clearness and power. Pimples or herpes can appear on the skin. It is usual to get the feeling of increased weight and tension, abdomen heaviness, which is due to the enhanced engorgement in the pelvis, which often causes irritation, itching and sometimes sexual excitement.

Menstruation disorders

Disorders of the normal menstrual cycle is one of the most common complaints when visiting the gynaecologist. It turns out that most of the women do not realize what exactly menstruation is and that they need to treat this period with caution.

The normal cycle varies in the following boundaries: interval between menstruations, considered from the first day of the following cycle – from 21 to 35 days, duration of bleeding – from 2 to 5 days, intensity – 20-60 ml (3-4 sanitary pads per day).

Abnormal menstruation can appear when: the duration between the cycles or the cycle itself are increased or decreased, beyond the boundaries cited above.

In each deviation from the norm, the woman should immediately visit her doctor.

Each disturbance of the menstruation appears to be the first sign of one coming genitals disease – inflammation, uterine polyps, endometriosis, and ectopic pregnancy. It is possible to have cancer of the cervix, uterus or ovaries!

Sometimes, but rarely, the menstrual cycle disturbances are not symptoms for diseases, but they are due to the environment influence. During the years of puberty, around the age of 12 – 16 years, after the first menstruation, one third of the girls have irregular periods.

This stage continues around two years, after that the menstruation gets regular.

Symptoms like sudden loss or gain of weight, hair growth, accompanied by an irregular period, should be seriously treated, as they could be a sign for future infertility or premature pregnancy. When menopause is coming (45-55 years), the period comes more rarely. Hormones formation and the maturing of the ovum stops in the period of about 5 years.

Menstrual products

Sanitary pads

Sanitary pad is an absorptive hygiene product, used by women during their month period and in every other case when there is bleeding from the vagina. The sanitary pad is used outside of the body, and it is put between the vulva and the woman’s underwear.

Sanitary pads have several variants: they could be made of silk or cotton, they could be thinner or thicker, with wings or without.


The tampon is a little roll of cotton fabric with a thread, hanging at the end.

Tampons are with different thickness, depending on the severity of bleeding. They are also with different length – there are even special, shorter tampons for girls who are still virgin, so that it is not possible to tear the hymen.

The tampons should be changed every couple of hours, and it is better to use sanitary pad during the night instead of a tampon. Changing the tampons so frequently is very important, because if the tampon is used for a longer period of time (24 hours for example) it could bring you damage and cause an infection.

What is an ovulation?

Ovulation is the time period when it is possible for a woman to conceive a baby.

Under the influence of a hormone, which is secreted by the pituitary gland, a few egg sells start getting ripe in the ovary. However only one of them gets to the surface of the ovary where it breaks and the mature egg cell, released from it moves in the fallopian tube. This is the ovulation. In the fallopian tube, again under the influence of a hormone, secreted from the pituitary gland, a yellow body is formed. It also synthesizes hormones–estrogen and progesterone, which function over the uterus mucosa, so that it is ready for the fertilized egg. It changes by increasing its volume and its blood flow gets better.

Calculation of ovulation in Period28.com

The ovulation in Period28.com is calculated on the basis of the standard method – counting the days from the beginning of the last menstruation and counting of 14 days.

Example: If the menstrual period of a woman stated on 5th January, her ovulations is usually after 14 days. That means it is on 19th January.

This calculation is on the basis of women statistics worldwide, however everything is quite individual! For the women who want to get pregnant and they want to be sure about their exact time of ovulation, the best method is making an ovulation test, which is sold in the pharmacies.

There are other known methods for defining the woman ovulation such as measuring the temperature, self-examination of the mucus from the cervix, etc., but according to the specialists gynaecologists they are not so reliable (for example the woman’s temperature is influenced by so many other factors).

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Your account is personal. The information can not be seen by anyone, except you.

Pap test

What is Pap test?

The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used to detect potentially pre-cancerous and cancerous processes in the endocervical canal (transformation zone) of the female reproductive system. Unusual findings are often followed up by more sensitive diagnostic procedures, and, if warranted, interventions that aim to prevent progression to cervical cancer. The test was invented by and named after the prominent Greek doctor Georgios Papanikolaou.

In taking a Pap smear, a speculum is used to open the vaginal canal and allow the collection of cells from the outer opening of the cervix of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses. The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium.

In general, in countries where Pap smear screening is routine, it is recommended that females who have had sex seek regular Pap smear testing. Guidelines on frequency vary from every three to five years. If results are abnormal, and depending on the nature of the abnormality, the test may need to be repeated in six to twelve months. If the abnormality requires closer scrutiny, the patient may be referred for detailed inspection of the cervix by colposcopy. The patient may also be referred for HPV DNA testing, which can serve as an adjunct to Pap testing. Additional biomarkers which may be applied as ancillary test with Pap test are evolving.

Types of screening:

Conventional Pap

In a conventional Pap smear, samples are smeared directly onto a microscope slide after collection.

Liquid based cytology

The Pap smear sample is put in a bottle of preservative for transport to the laboratory, where it is then smeared on the slide.

In addition, an HPV test may be performed either as indicated for abnormal Pap results, or in some cases dual testing is done, where both a Pap smear and HPV test are done.


Screening guidelines vary from country to country. In general, screening starts about the age of 20 or 25 and continues until about the age of 50 or 60. Screening is typically recommended every three to five years, as long as results are normal.

Women should wait a few years after they first have intercourse before they start screening, and should not be screened before age 21. American Congress of Obstetricians and Gynecologists (ACOG) and others recommend starting screening at age 21 (since that is a few years after initial sex for most American women). Many other countries wait until age 25 or later to start screening. For instance, some parts of Great Britain start screening at age 25.

Most women who contract HPV do so soon after becoming sexually active. It takes an average of a year, but can take up to four years, for a woman's immune system to control the initial infection. Screening during this period may show this immune reaction and repair as mild abnormalities, which are usually not associated with cervical cancer, but could cause the woman stress and result in further tests and possible treatment. Cervical cancer usually takes time to develop, so delaying the start of screening a few years poses little risk of missing a potentially precancerous lesion. For instance, screening women under age 25 does not decrease cancer rates under age 30.

There is little or no benefit to screening women who have not had sexual contact. For example, United States Preventive Services Task Force (USPSTF) recommends waiting at least three years after first sex. HPV can be transmitted in sex between women, so women who have only had sex with other women should be screened, although they are at somewhat lower risk for cervical cancer.

Guidelines on frequency of screening vary—typically every three to five years for those who have not had previous abnormal smears. Some older recommendations suggested screening as frequently as every one to two years, however there is little evidence to support such frequent screening; annual screening has little benefit but leads to greatly increased cost and many unnecessary procedures and treatments. It has been acknowledged since before 1980 that most women can be screened less often. In some guidelines, frequency depends on age; for instance in Great Britain, screening is recommended every 3 years for women under 50, and every 5 years for those over.

Screening should stop about age 65 unless there is a recent abnormal tests or disease. There is probably no benefit screening women aged 60 or over whose previous tests have been negative. If a woman's last three Pap results were normal, she can stop at age 65, according to the USPSTF, ACOG, ACS and ASCP; England's NHS says 64. There is no need to continue screening after a complete hysterectomy for benign disease.

Pap smear screening is still recommended for those who have been vaccinated against HPV, since the vaccines do not cover all of the HPV types that can cause cervical cancer. Also, the vaccine does not protect against HPV exposure before vaccination.

More frequent Pap smears may be needed to follow-up after an abnormal Pap smear, or after treatment for abnormal Pap or biopsy results, or after treatment for cancer.

Cervical screening Procedure

For best results, a Pap test should not occur when a woman is menstruating. However, Pap smears can be performed during a woman's menstrual period, especially if the physician is using a liquid-based test; if bleeding is extremely heavy, endometrial cells can obscure cervical cells, and it is therefore inadvisable to have a Pap smear if bleeding is excessive.

Obtaining a pap smear should not cause pain, but it can if the patient has certain untreated vaginal problems such as cervical stenosis or vaginismus, or if the person performing it is too harsh, or uses the wrong size speculum. The patient should speak up if they are in pain. Many women experience spotting or mild diarrhea afterward.

Many health care providers are under the false impression that only sterile water, or no lubricant at all, should be used to lubricate the speculum. This may result in unnecessary discomfort. A number of studies have shown that using a small amount of water-based gel lubricant does not interfere with, obscure, or distort the PAP smear. Further, cytology is not affected nor some STD testing.

The health care worker begins by inserting a speculum into the woman's vagina, which spreads the vagina open and allows access to the cervix. The health care provider then collects a sample of cells from the outer opening or os of the cervix by scraping it with an Aylesbury spatula. An endocervical brush is rotated in the central opening of the cervix. The cells are placed on a glass slide and taken to the laboratory to be checked for abnormalities.

A plastic-fronded broom is sometimes used in place of the spatula and brush. The broom is not as good a collection device, since it is much less effective at collecting endocervical material than the spatula and brush. The broom is used more frequently with the advent of liquid-based cytology, although either type of collection device may be used with either type of cytology.

The sample is stained using the Papanicolaou technique, in which tinctorial dyes and acids are selectively retained by cells. Unstained cells cannot be seen with a light microscope. Papanicolaou chose stains that highlighted cytoplasmic keratinization, which actually has almost nothing to do with the nuclear features used to make diagnoses now.

In some cases, a computer system may prescreen the slides, indicating those that do not need examination by a person or highlighting areas for special attention. The sample is then usually screened by a specially trained and qualified cytotechnologist using a light microscope. The terminology for who screens the sample varies according to the country; in the UK, the personnel are known as cytoscreeners, biomedical scientists (BMS), advanced practitioners and pathologists. The latter two take responsibility for reporting the abnormal sample which may require further investigation.

Effectiveness of Pap test

The Pap test, when combined with a regular program of screening and appropriate follow-up, can reduce cervical cancer deaths by up to 80%.

Failure of prevention of cancer by the Pap test can occur for many reasons, including not getting regular screening, lack of appropriate follow up of abnormal results, and sampling and interpretation errors. In the US, over half of all invasive cancers occur in women that have never had a Pap smear; an additional 10 to 20% of cancers occur in women that have not had a Pap smear in the preceding five years. About one-quarter of US cervical cancers were in women that had an abnormal Pap smear, but did not get appropriate follow-up (woman did not return for care, or clinician did not perform recommended tests or treatment).

Adenocarcinoma of the cervix has not been shown to be prevented by Pap tests. In the UK, which has a Pap smear screening program, Adenocarcinoma accounts for about 15% of all cervical cancers.

Estimates of the effectiveness of the United Kingdom's call and recall system vary widely, but it may prevent about 700 deaths per year in the UK. A medical practitioner performing 200 tests each year would prevent a death once in 38 years, while seeing 152 women with abnormal results, referring 79 for investigation, obtaining 53 abnormal biopsy results, and seeing 17 persisting abnormalities lasting longer than two years. At least one woman during the 38 years would die from cervical cancer despite being screened.

Since the population of the UK is about 61 million, the maximum number of women who could be receiving Pap smears in the UK is around 15 million to 20 million (eliminating the percentage of the population under 20 and over 65). This would indicate that the use of Pap smear screening in the UK saves the life of 1 person for every approximately 20,000 people tested (assuming 15,000,000 are being tested yearly). If only 10,000,000 are actually tested each year, then it would save the life of 1 person for every approximately 15,000 people tested.